#HEALTH: When weight-loss needs medical intervention

FOR many, weight management is synonymous with diet changes, physical activity and daily habits. For others, this may not be as straightforward.

Obesity is a chronic and complex condition and biological factors affecting appetite, metabolism and weight regulation can make sustained weight loss a challenge.

For some people, additional medical interventions, including prescription weight-management medicines or bariatric surgery, may be necessary.

These treatments are not replacements for healthy lifestyle habits. Instead, they can work alongside nutrition, physical activity and behavioural changes to help patients achieve greater and more sustainable weight loss and improve conditions such as type 2 diabetes, high blood pressure, sleep apnoea and cardiovascular risk, says Sunway Medical Centre Velocity (SMCV) consultant physician and endocrinologist Dr Mak Woh Wei.

"GLP-1 is a hormone that our body naturally produces, particularly after we eat. One of its roles is to help regulate appetite, food intake and blood sugar levels. Medicines that act on the GLP-1 pathway essentially enhance these effects," explains Dr Mak.

They can help people feel fuller for longer, reduce hunger and cravings, and slow the movement of food from the stomach into the intestine. They also help the body regulate blood glucose by improving insulin secretion when glucose levels are elevated and reducing inappropriate glucagon release.

However, these medications are not a quick fix for weight loss and are only considered for people who meet a specific criteria for weight management, cautions Dr Mak.

Factors such as the patient's body mass index (BMI), health conditions, other medications, medical history and treatment goals all come into play.

"Most importantly, medication does not replace healthy lifestyle habits. Nutrition, physical activity, sleep and behavioural support remain important parts of long-term weight management."

These medicines should not be started or adjusted without appropriate medical supervision, adds Dr Mak.

"Monitoring allows us to assess how the patient is responding, manage side effects, review other medications and determine whether the treatment remains appropriate."

Self-medicating through unofficial channels is highly risky as there may be risks of improper storage, contamination, counterfeit products or inappropriate dosing.

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GOING UNDER THE KNIFE

SMCV consultant general and upper gastrointestinal surgeon Dr Mohanarajah Silvarajah explains that bariatric surgery becomes a consideration when structured non-surgical treatment has not produced sufficient or durable weight loss or improvement in obesity-related disease, and the person's BMI and health risks make the potential benefits outweigh the risks.

Assessment is not based on BMI alone, but clinicians also consider factors such as the severity and duration of obesity, previous attempts at weight loss (including appropriate medication, diabetes control and other comorbidities), eating behaviours and mental health status, alcohol or substance abuse, and the ability to comply with follow-ups, vitamin supplementation and lifestyle recommendations.

While bariatric surgery is generally safe, it is still major surgery and carries short-term surgical risks, as well as lifelong nutritional metabolic consequences, he explains.

Furthermore, as patients will eat considerably less after surgery, and with some procedures altering nutrient absorption, deficiencies can develop in iron, vitamin B12, folate, vitamin D, calcium, thiamine (vitamin B1) and protein.

This is why patients generally require lifelong vitamin and mineral supplementation and regular blood tests after bariatric surgery, especially since severe deficiencies can occasionally cause neurological or bone complications.

Dr Mohanarajah says bariatric surgery is neither a quick fix, nor something to be feared unnecessarily.

It is an evidence-based metabolic treatment that can dramatically improve health for appropriately selected patients, but works best when combined with lifelong follow-ups and lifestyle support.

Whether through GLP-1 medicines or bariatric surgery, obesity treatment is ultimately about improving one's health, not simply reducing weight.

"We need to recognise that maintaining weight loss can be challenging. The body has biological mechanisms that can increase hunger and promote weight regain after weight loss. This is one reason why obesity should be approached as a long-term condition rather than something that is simply 'cured' through a short-term diet."

Treatment needs to be individualised and sustainable. Depending on the patient, this may involve nutrition and physical activity, behavioural support, medication, and in appropriate cases, metabolic or bariatric surgery.

"The goal is not simply to help someone lose weight quickly. It is to help them achieve meaningful improvements in health that they can maintain over time," explains Dr Mak.

Ultimately, successful obesity treatment is about healthier years, better quality of life and sustainable health — not just a number on the scale.

Modern obesity treatment is not a "one-size-fits-all" approach either.

For some people, lifestyle intervention may be enough. Others may benefit from medication.

For people with more severe obesity or significant complications, surgery may provide a much greater metabolic benefit. These treatments can also be combined at different stages. The important thing is to start the conversation, get properly assessed and choose a treatment plan that you can sustain for the long term, says Dr Mohanarajah.

"Obesity is treatable, and you don't have to manage it alone," he says.